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Gluten Syndrome

The Gluten Syndrome

Oats - can they be part of a gluten-free diet?

There has been controversy for years as to whether it is okay, or not okay, to eat oats if you are gluten-sensitive.

Clinical studies have now provided very good evidence that oats do not damage the gut mucosa in most people who have coeliac disease. Following this, guidelines from some Coeliac Societies now accept that moderate amounts of oats can be consumed by most coeliacs without risk.

Many experts concerned with coeliac disease have now concluded that oats are safe for coeliacs, as long as they limit their consumption to amounts “found to be safe” in these research studies. This quantity is up to one-half cup of dry whole-grain rolled oats per day. Of course, any oats that are consumed need to be free of any contamination from other grains.

Half a cup of oats each day is usually okay

Here is some of the information that this opinion is based on:

A study in Finland looked at 52 coeliacs who were in remission and who had been on a gluten-free diet for more than a year. They all had a duodenal-biopsy, then they ate about 50 grams of oats (half a cup) per day over the next six months. Finally, they had a second biopsy. None of the people had any villus damage .

Your gut can heal whilst eating oats

Another group studied 40 newly diagnosed coeliacs in the same way. As expected, their initial biopsy showed significant villus damage (this was of course because they were still on a gluten-containing diet until they began the study). These people started on their gluten-free diet as well as eating their 50 grams of oats each day for 12 months. At the end of the year, their biopsies showed no damage to their villi. The meaning of this study was that their damaged villi were able to heal while eating oats.

A few people get unwell eating oats

However, other studies have found that not all people with coeliac disease are able to tolerate oats. Especially, those who also have dermatitis herpetiformis. Researchers report that although oats are well tolerated by most coeliacs, they did find a few exceptions. Several people recounted initial abdominal discomfort and bloating. A few patients have been found to eventually develop total villous atrophy during an oat challenge.

Yet another study has investigated 20 adult coeliacs who were in remission, to see if they could eat even larger amounts of oats in their daily gluten-free diet. They consumed about 100 grams (one cup) of uncontaminated rolled oats in their daily diet for over a year. They were tested four times during the study period. This included small bowel endoscopy and blood samples. They experienced no gut symptoms. Also, there were no adverse effects seen in small bowel histology or in their blood test results. The conclusion was that the vast majority of adults with coeliac disease could include large amounts of rolled oats in their diet without problems.

Oats have also been studied in children. A group of ten children with coeliac disease were investigated at the time of their diagnosis. They were put on a gluten-free diet but they were also eating about 25 grams (quarter of a cup) of rolled oats each day. After six months they were tested again. There was improvement in both their small bowel histology and their tissue transglutaminase antibody results.

Children tolerate oats well

However, there is still a word of caution. Oat proteins have been shown to trigger the immune response of cells taken from coeliac people. Therefore, the long-term effects of oat cereal added to a gluten-free diet in children still need to be determined.

Oats are useful fibre

The ability to use oats in your diet gives an important source of fibre as well as other important nutrients. This is very important in children who have other food allergies. If you are also allergic to cow’s milk and eggs, then going gluten-free is a big task. Therefore, if oats can be tolerated, this makes food planning just a little bit easier.

Each person will have to work out whether or not they can tolerate oats for themselves. This needs to be determined both clinically and with follow-up blood tests.

Finally, some gluten experts have expressed some further concerns about oats. These are:

Some food chemistry research studies suggest that avenin protein in oats does have toxic properties.
The purity of oat products in some countries is suspect. Oats and oat products can inadvertently be contaminated with wheat. This can occur during harvesting, milling and processing.
There is a possibility that gut damage from oats takes longer than six to twelve months to show up. Also, symptoms might not be readily apparent to the person.
The possibility that young children might have a higher cross-sensitivity to oats because of their relatively immature immune system.

These are real concerns. It is important that gluten-sensitive people know about the oats story. Whether or not they choose to eat oats, they should be under some sort of regular medical evaluation and supervision. However, the common opinion is that the long-time consumption of oats as part of the gluten-free diet is well tolerated among the vast majority of those with coeliac disease.

Dr Rodney Ford
Food allergy and Gluten expert

I am a ZERO gluten man

Yes! I am a ZERO gluten man. This is based on the concern that tiny amounts of gluten in your food are enough to stimulate your immune system – even if you are not feeling directly unwell from the trivial exposure. What is trivial to you is not trivial to your highly tuned & sensitive immune system.

By definition, Zero gluten means ZERO! In other words – it is undetectable gluten (say less than 1ppm – gluten detection is now getting down to these very low levels). Consequently, ANY FOOD that has gluten detected between 5-20ppm should NOT be labeled GF. It is NOT gluten-free, even if it contains an apparently trivial amount. It needs to be labeled 5-20ppm!!! We need to know what is in our food! We need this information to make healthy food choices.

Although the manufacturers say this is not practical to make ZERO gluten products, it is if enough effort is put into cleaning up the contaminated food chain. The ZERO gluten market is growing. The GF community does not want gluten traces in their food. If we people do not buy their products - then they will have to change - or decide that they will not chase the GF market.

Yes, sensible labeling needed.

I propose a 3-tier system: zero gluten, less that 20ppm gluten, and glutened. It is that simple. Then we know what we are getting. How hard is this! Everyone satisfied. Why does the FDA just want one definition? It cannot be done – that is why they have had this “problem “ on their too-hard pile for the last 7 years!

Another piece of sound advise from Gluten Free Planet

Gluten-free: is this the only way to manage celiac disease?

Well, the simplistic answer to this question is “yes”. However this is a complex question. To narrow the question, I will first assume that coeliac disease means that ‘a diagnosis has been made by endoscopy showing the characteristic flatness/atrophy of the small bowel mucosa’ (I will address the question of how early you can diagnose coeliac disease in a later blog).

Yes, a gluten-free diet is the central management strategy for coeliac disease. But what does gluten-free mean? A gluten free diet means zero gluten for life. No exemptions. Certainly there are many people who suggest that people can eat gluten to tolerance. I disagree. Any gluten has the potential to cause you harm.

But does zero gluten literally mean non-at-all? The most complex part of answering this question is “what does a zero-gluten-diet mean in terms of every-day practicality?” Recently, there has been a lot of debate about how many parts per million (ppm) of gluten is acceptable in food. Pragmatically, because it is so difficult to get rid of cross-contamination in food production and processing, the number of 20 ppm is now surfacing as a reasonable level of gluten to be consumed (some countries have 200ppm, and the FDA likely to agree to 20ppm). This seems to be a negligible amount. However, there are still concerns for some people who seem to be exquisitely sensitive to gluten.

For me zero-gluten means no gluten. This can be achieved if you eat fresh fruits and vegetables, unprocessed meat and fish, uncontaminated rice, corn and other alternate grains, and unprocessed dairy foods and eggs, nuts also. This means no packet or processed foods.

But it is a lot more that ‘just’ going gluten-free. Yes, there are a lot more things to do for healing someone with coeliac disease. The longer that you have had coeliac disease, the worse your body will be. More healing will be required. You may need additional minerals, vitamins and probiotics. There are a number of routine health checks to take. You should also ensure that your gut has healed (via blood test and maybe repeat endoscopy).

There is talk about vaccines for coeliac disease. I think these are a long way off. On top of this gluten is a trigger for many autoimmune diseases and neurologic conditions. So giving pharmaceutical treatment for coeliac disease will still not remove the threat of gluten to your body.

Zero gluten is the main stay of treatment for coeliac disease. I do not see this changing much in the future. I do see the gluten-free lifestyle being very widely adopted over the next decade. I do see better non-gluten grains. I do see a generation in much better nutritional health.

Dr Rodney Ford, Author of The Gluten Syndrome

Dermatitis herpetiformis

Dermatitis herpetiformis (DH) is one of the many problems caused by gluten-sensitivity.

Dermatitis herpetiformis is a very itchy skin condition. It can start suddenly. It tends to affect the elbows, knees, buttocks, scalp, and back. It begins as little bumps that then change into little blisters.

The condition is thought to be caused by tiny clumps or deposits under the skin. These deposits are made up by a combination of IgA-gliadin and gluten (these deposits are known as immune-complexes). These deposits occur as a result of eating gluten. These deposits take a very long time to clear up once you start on a gluten-free diet. It can take up to ten years before you make a full recovery.

To make a definite diagnosis, you need to have a skin biopsy. Which, if positive, will show these clumps of immune complexes of gluten/gluten antibody. A skin biopsy cannot diagnose celiac disease. For that you need the gut biopsy.

Most people with dermatitis herpetiformis do not have troublesome gut symptoms. However, most (about 80%) do have some damage in their intestine when it is looked for. So, all DH sufferers should be tested for celiac disease (that means relevant blood tests and then a small bowel biopsy via endoscopy). About 5% of celiac patients will develop dermatitis herpetiformis. Sometimes it can even develop after starting the gluten-free diet. This is probably due to the long lasting nature of the IgA immune-complex deposits in the skin.

Eczema: the skin is often a target organ in gluten-sensitivity: eczema can also be precipitated by gluten. Therefore, people with persistent eczema should get a blood test for their IgG-gliadin levels. This is a common manifestation of gluten-sensitivity.

ZERO gluten

Often I am asked: "How strict do I have to be?"

"Does a little bit of gluten-food now and then really matter?"

YES IT DOES!

The word that I use for gluten is "ZERO". I have come to this conclusion because it is important for your antibodies against gluten to slowly disappear. Every time that you have gluten (by error or as a deliberate choice) you stimulate your immune system to continue to produce these potentially harmful antibodies again. This undoes a lot of the work that you have been doing to dampen down the gluten reactions.

So I say Gluten free means ZERO gluten - not negotiable.

To achieve this, you will need to be absolutely convinced about your "gluten-induced-disease" (get a confirmed diagnosis and get the correct set of blood tests). Also develop a group of people around you (who understand the gluten thing) who can help and nourish your diet path. AND, you can help them. Join our facebook page - that will help too.

The simple answer is "ZERO gluten"

Cheers Rodney

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